上所论二方，皆治太阳与阳明合病之方也。乃有其病原属太阳，误治之后，而又纯属阳明者，葛根黄芩黄
连汤所主之病是也。
《伤寒论》原文∶太阳病桂枝证，医反下之，利遂不止，脉促
者，表未解也，喘而汗出者，葛根黄芩黄连汤主之。
【葛根黄连黄芩汤方】葛根半斤，甘草二两炙，黄芩三两，黄连三两。
上四味，以水八升，先煮葛根减二升，纳诸药煮取二升，去渣，分温再服。
促脉与结、代之脉皆不同，注疏诸家多谓，脉动速时一止者曰促。夫促脉虽多见于速脉之中，而实非止
也。譬如，人之行路，行行且止，少停一步复行，是结、代也。又譬如人之奔驰，急急速走，路中偶遇不平，
足下恒因有所龃龉，改其步武，而仍然奔驰不止，此促脉也。是以促脉多见于速脉中也。凡此等脉，多因
外感之热内陷，促其脉之跳动加速，致脉管有所拥挤，偶现此象，名之为促，若有人催促之使然也。故方
中重用芩、连，化其下陷之热，而即用葛根之清轻透表者，引其化而欲散之热尽达于外，则表里俱清矣。且喘
为肺病，汗为心液，下陷之热既促脉之跳动改其常度，复迫心肺之阳外越，喘而且汗，由斯知方中芩、连，
不但取其能清外感内陷之热，并善清心肺之热，而汗喘自愈也。
况黄连性能浓肠，又为治下利之要药乎。若服药后，又有余热利不止者，宜治以拙拟滋阴宣解汤。
陆九芝曰∶温热之与伤寒所异者，伤寒恶寒，温热不恶寒耳。恶寒为太阳主证，不恶寒为阳明主证，仲
景于此分之最严。恶寒而无汗用麻黄，恶寒而有汗用桂枝，不恶寒而有汗且恶热者用葛根。阳明之葛根，即太
阳之桂枝也，所以达表也。葛根黄连黄芩汤中之芩、连，即桂枝汤中之芍药也，所以安里也。桂枝协麻黄
治恶寒之伤寒，葛根协芩、连治不恶寒之温热，其方为伤寒、温热之分途，任后人审其病之为寒为热而分
用之。尤重在芩、连之苦，不独可降可泻，且合苦以坚之之义，坚毛窍可以止汗，坚肠胃可以止利，所以葛
根黄芩黄连汤又有下利不止之治，一方而表里兼清，此则药借病用，本不专为下利设也。乃后人视此方若舍
下利一证外，更无他用者何也！
用此方为阳明温热发表之药可为特识，然葛根发表力甚微，若遇证之无汗者，当加薄荷叶三钱，始能透
表出汗，试观葛根汤治项背强KT KT 无汗恶风者，必佐以麻、桂可知也。当仲景时薄荷尚未入药，前曾
论之。究之清轻解肌之品，最宜于阳明经病之发表，且于温病初得者，不仅薄荷，若连翘、蝉蜕其性皆与
薄荷相近，而当仲景时，于连翘止知用其根（即连轺赤小豆汤中之连轺）以利小便，而犹不知用连翘以发表。
至于古人用蝉，但知用蚱蝉，是连其全身用之，而不知用其退有皮以达皮之妙也。盖连翘若单用一两，能
于十二小时中使周身不断微汗。若止用二三钱于有薄荷剂中，亦可使薄荷发汗之力绵长。至蝉蜕若单用三钱
煎服，分毫不觉有发表之力，即可周身得微汗，且与连翘又皆为清表温疹之妙品以辅佐薄荷奏功，故因
论薄荷而连类及之。
【附录】后世用葛根黄芩黄连汤分量
葛根（四钱） 甘草（一两炙） 黄芩（一钱五分） 黄连（一钱五分）
不下利者，去黄连加知母三钱。无汗者，加薄荷叶、蝉蜕各钱半。
上文论述的两个方剂，都是治疗太阳病与阳明病合病的方子。然而有一种情况，其病因原本属于太阳病，经过误治之后，变成了纯属阳明病的证候，这就是葛根黄芩黄连汤所主治的疾病。
《伤寒论》原文记载：太阳病出现桂枝汤证（表现为发热、恶风、汗出），医生反而使用攻下法治疗，导致腹泻不止，脉象急促的，说明表邪尚未解除；如果伴有气喘且出汗的，应当用葛根黄芩黄连汤主治。
【葛根黄芩黄连汤方】葛根半斤，甘草二两（炙），黄芩三两，黄连三两。
以上四味药，用水八升，先煮葛根，水量减少二升后，加入其他药物，煎煮至取药液二升，滤去药渣，分两次温服。
促脉与结脉、代脉都不同，历代注解疏释的医家大多认为，脉搏跳动快速且偶尔有一次停顿的叫做促脉。其实促脉虽然多见于快速脉象中，但实际上并没有停顿。打个比方，人走路时，走几步停一下，稍作停留后再继续走，这是结脉或代脉的表现。又比如人在奔跑时，急急忙忙地跑，路上偶然遇到不平之处，脚下因为有所阻碍而改变步伐节奏，但仍然奔驰不停，这才是促脉的表现。所以促脉多出现在快速脉象中。凡是这类脉象，多是因为外感的热邪内陷体内，促使脉搏跳动加速，导致脉管充盈拥挤，偶尔呈现这种形象，命名为促脉，就像有人催促一样。因此方中重用黄芩、黄连，来化解内陷的热邪，同时利用葛根清轻透达肌表的特性，引导那些已经化热想要发散的热邪完全透达于体表之外，这样表里两方面的热邪就都清除了。况且气喘是肺部的病变，汗液是心液的体现，内陷的热邪既促使脉搏跳动改变了常态，又逼迫心肺的阳气向外浮越，导致气喘而且出汗，由此可知方中的黄芩、黄连，不仅取其能清除外感内陷的热邪，并且善于清除心肺的热邪，那么气喘和出汗自然就会痊愈。
更何况黄连的药性能够浓固肠道，又是治疗腹泻的重要药物呢。如果服药后，还有余热未清、腹泻不止的情况，适宜用我自己拟定的滋阴宣解汤来治疗。
陆九芝说：温热病与伤寒的不同之处，在于伤寒患者怕冷，而温热病患者不怕冷而已。怕冷是太阳病的主要证候，不怕冷是阳明病的主要证候，张仲景对此区分得非常严格。怕冷且无汗的用麻黄汤，怕冷且有汗的用桂枝汤，不怕冷且有汗且怕热的用葛根汤。阳明病用的葛根，就相当于太阳病用的桂枝，都是为了通达表邪。葛根黄芩黄连汤中的黄芩、黄连，就相当于桂枝汤中的芍药，都是为了安守里气。桂枝配合麻黄治疗怕冷的伤寒，葛根配合黄芩、黄连治疗不怕冷的温热病，这两个方剂代表了伤寒和温热病治疗的分歧路线，任凭后人根据病情是寒是热而分别使用。尤其重要的是黄芩、黄连的苦味，不仅可以降逆泻火，而且符合“苦以坚之”的理论，坚固毛窍可以止汗，坚固肠胃可以止利，所以葛根黄芩黄连汤又有治疗腹泻不止的功效，一方兼顾表里双清，这其实是药物顺应病势发挥作用，本意并不专门是为治疗腹泻而设立的。可是后人把这个方子看作除了治疗腹泻这一症状外，没有其他用途，这是为什么呢！
使用这个方子作为治疗阳明温热病发表的药物可以说是独到的见解，然而葛根的发表力量非常微弱，如果遇到没有汗出的证候，应当加三钱薄荷叶，才能透达表邪并出汗。试看葛根汤治疗项背强几几（形容颈背部僵硬不舒）且无汗怕风的证候，必须佐以麻黄、桂枝就可以知道了。在张仲景的时代，薄荷还没有被纳入药用，之前曾经论述过。究其根本，性质清轻、能解肌退热的药物，最适合用于阳明经病的发表，而且在温病初起时，不仅仅是薄荷，像连翘、蝉蜕它们的药性都与薄荷相近，但在张仲景时代，对于连翘只知道用它根（即连轺，用于赤小豆汤中）来利尿，还不知道用连翘来发表。至于古人使用蝉，只知道用蚱蝉，是将它全身一起使用，而不知道用它的蜕皮（蝉蜕）来达到透发皮肤邪气的妙处。大概连翘如果单独使用一两，能在十二小时内使周身不断微微出汗。如果只使用二三钱配合在有薄荷的方剂中，也能使薄荷发汗的力量绵长持久。至于蝉蜕如果单独使用三钱煎服，丝毫感觉不到有发表的力量，却能使周身得到微汗，而且连翘和蝉蜕都是清透表邪、治疗温疹的妙品，用来辅助薄荷奏效，所以我因讨论薄荷而连带提及它们。
【附录】后世使用葛根黄芩黄连汤的剂量
葛根（四钱） 甘草（一两，炙） 黄芩（一钱五分） 黄连（一钱五分）
如果不腹泻的，去掉黄连，加知母三钱。如果没有汗出的，加薄荷叶、蝉蜕各一钱半。
The two formulas discussed above are both used to treat the combined disease of Taiyang (Greater Yang) and Yangming (Yang Brightness). However, there is a condition where the pathogen originally belonged to Taiyang, but after mismanagement, it becomes purely a Yangming condition. This is the condition governed by Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction).
Original text from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): In a Taiyang disease presenting with Guizhi Tang syndrome, if the physician erroneously applies purgation, diarrhea persists incessantly. If the pulse is Cu (Rapid and Interrupted), it indicates that the exterior pathogen has not yet resolved. If accompanied by wheezing and sweating, Gegen Qinlian Tang should be primarily administered.
[Formula: Gegen Qinlian Tang] Gegen Radix Puerariae (48g), Gancao Radix Glycyrrhizae Preparata (12g, honey-fried), Huangqin Cortex Scutellariae (18g), Huanglian Rhizoma Coptidis (18g).
Take the above four ingredients, add eight sheng of water. First decoct Gegen until the volume reduces by two sheng, then add the remaining herbs. Decoct until two sheng remain, strain off the dregs, and divide into two warm doses for administration.
The Cu (Rapid and Interrupted) pulse differs from the Jie (Knotted) and Dai (Intermittent) pulses. Most commentators define the Cu pulse as a rapid pulse with occasional pauses. Although the Cu pulse often appears in rapid pulses, it does not actually involve a pause. Consider this analogy: when a person walks, stopping occasionally before continuing, this represents the Jie or Dai pulse. Conversely, when a person runs hurriedly, encountering an uneven spot on the road causes a slight stumble or change in rhythm, yet the running continues without cessation; this represents the Cu pulse. Thus, the Cu pulse is frequently seen in rapid pulses. Such pulses usually result from exogenous heat sinking inward, accelerating the heartbeat and causing congestion in the pulse vessels, creating this image as if urged by someone. Therefore, the formula heavily employs Huangqin and Huanglian to transform the sunken heat. Simultaneously, using Gegen's clear and light properties to penetrate the exterior guides the transformed heat, which desires to dissipate, completely outwards, thereby clearing both interior and exterior heat. Furthermore, wheezing is a lung pathology, and sweat is the fluid of the heart. The sunken heat accelerates the pulse beyond its normal rhythm and forces the Yang qi of the heart and lungs to float outward, resulting in wheezing and sweating. From this, we know that Huangqin and Huanglian not only clear the exogenous heat that has sunk inward but also effectively clear heat from the heart and lungs, allowing wheezing and sweating to resolve spontaneously.
Moreover, Huanglian possesses the property of thickening the intestines and is a crucial herb for treating diarrhea. If, after taking the medicine, residual heat remains and diarrhea persists, one should treat it with my self-formulated Ziyin Xuanjie Tang (Nourish Yin and Vent Outward Decoction).
Lu Jiuzhi stated: The difference between Warm-Heat diseases and Cold Damage lies in the fact that Cold Damage patients experience aversion to cold, whereas Warm-Heat patients do not. Aversion to cold is the primary symptom of Taiyang; absence of aversion to cold is the primary symptom of Yangming. Zhang Zhongjing distinguished these most strictly. For aversion to cold without sweat, use Mahuang Tang; for aversion to cold with sweat, use Guizhi Tang; for no aversion to cold with sweat and aversion to heat, use Gegen Tang. Gegen in Yangming disease corresponds to Guizhi in Taiyang disease, both serving to release the exterior. Huangqin and Huanglian in Gegen Qinlian Tang correspond to Shaoyao in Guizhi Tang, both serving to stabilize the interior. Guizhi assists Mahuang to treat Cold Damage with aversion to cold; Gegen assists Huangqin and Huanglian to treat Warm-Heat without aversion to cold. These formulas represent the divergent paths for treating Cold Damage and Warm-Heat, allowing later generations to choose based on whether the disease is cold or heat. Crucially, the bitterness of Huangqin and Huanglian not only descends and purges but also adheres to the principle of "bitterness to consolidate." Consolidating the hair follicles stops sweating; consolidating the intestines and stomach stops diarrhea. Thus, Gegen Qinlian Tang treats persistent diarrhea. One formula clears both exterior and interior. This utilizes the drug according to the disease's nature, not specifically designed solely for diarrhea. Why do later generations view this formula as having uses other than treating diarrhea?
Using this formula as an exterior-releasing agent for Yangming Warm-Heat disease demonstrates unique insight. However, Gegen's power to release the exterior is very weak. In cases without sweat, one should add three qian of Bohe Ye (Menthae Haplocalycis Folium) to effectively vent the exterior and induce sweating. Observe that Gegen Tang treats stiffness of the neck and back with aversion to wind and no sweat, requiring assistance from Mahuang and Guizhi. During Zhang Zhongjing's time, Bohe was not yet used in medicine, as previously discussed. Fundamentally, herbs that are clear, light, and resolve the muscle layer are most suitable for releasing the exterior in Yangming meridian diseases. In early-stage Warm diseases, not only Bohe, but also Lianqiao Fructus Forsythiae and Chantui Periostracum Cicadae have properties similar to Bohe. However, in Zhang Zhongjing's time, Lianqiao root (Lianyao) was known only for promoting urination in Chixiaodou Tang, and its use for releasing the exterior was unknown. Regarding cicadas, ancients used the whole body of the cicada (Zhechan) but did not know the efficacy of its shed skin (Chantui) in reaching the skin. Generally, if Lianqiao is used alone at one liang, it can induce continuous mild sweating over twelve hours. If only two or three qian are used with Bohe, it can prolong the diaphoretic effect of Bohe. Chantui, if used alone at three qian, shows no apparent exterior-releasing power, yet can induce mild sweating throughout the body. Both Lianqiao and Chantui are excellent products for clearing the exterior and treating warm rashes, assisting Bohe in achieving its effect. Thus, discussing Bohe leads to mentioning them.
[Appendix: Dosages of Gegen Qinlian Tang in Later Generations]
Gegen Radix Puerariae (4 qian), Gancao Radix Glycyrrhizae Preparata (1 liang, honey-fried), Huangqin Cortex Scutellariae (1.5 qian), Huanglian Rhizoma Coptidis (1.5 qian).
If there is no diarrhea, remove Huanglian and add Zhimu Rhizoma Dioscoreae Bungeanae (3 qian). If there is no sweat, add Bohe Ye Menthae Haplocalycis Folium and Chantui Periostracum Cicadae (1.5 qian each).